Concussions

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What is a concussion?

A concussion is a mild traumatic brain injury caused by a bump, jolt, or blow to the head. The sudden movement causes the brain to bounce around or twist inside the skull. This leads to stretching and damaging of brain cells and chemical changes in the brain. A jolt to the body can also cause a concussion if the impact is strong enough to cause the head to forcefully jerk backwards, forwards, or to the side.

A concussion is classified as “mild” because it is not usually life-threatening. However, the effects from a concussion can be serious and last for days, weeks, or even longer.

What causes a concussion?

Motor vehicle accidents, falls, and sports injuries are common causes of concussions. Any sport that involves contact can result in a concussion.

Among children, most concussions happen on the playground, while bike riding, or when playing sports such as football, basketball, or soccer.

What are the symptoms of a concussion?

The most common symptom of a concussion is a headache. This is an especially serious symptom if the headache gets worse over time, which might mean that there is bleeding in the skull.

Other symptoms include:

  • Nausea
  • balance problems/dizziness
  • double or blurry vision
  • sensitivity to light and noise
  • fatigue or drowsiness
  • changes in sleep patterns
  • trouble comprehending and/or concentrating
  • depression
  • irritability, nervousness, or sadness
  • feelings of being “just not right” or in a “fog”

Other danger signs are:

  • seizures
  • not knowing people or places
  • unusual behavior

In children, the signs to seek emergency treatment include:

  • any of the adult symptoms listed above
  • will not stop crying or calm down
  • will not nurse or eat

What factor does age play in concussion risk?

Adolescents are at higher risk because of their developing brains. The high school athlete has a greater risk than the college athlete, and the college athlete a greater risk than the professional athlete.

When do concussion symptoms appear?

Concussion symptoms usually appear within minutes of the blow to the head. Some symptoms may take several hours to appear. Symptoms can change days later; others can develop when the brain is stressed by such activities as reading or running.

How is a concussion diagnosed?

The doctor will check for physical, thinking, and mood symptoms and try to determine if the head trauma is a concussion, skull fracture, or something else. A CT scan or MRI might be done to check for bleeding inside the skull. However, these tests do not show the cell injuries caused by a concussion.

In addition, the following methods may be used in diagnosing a concussion:

  • Overnight observation in a hospital (for more serious cases)
  • Verbal, written, or computerized tests or checklists to determine memory, ability to pay attention and concentrate, and the ability to solve problems correctly in a reasonable amount of time

How is a concussion treated?

The main treatment for a concussion is rest. Your doctor may tell you to take time off from work or school. Over time, the symptoms will go away as your brain heals.

Symptoms typically last about 6 to 10 days, depending on how severe the concussion is. Most people get better within a week. People with symptoms that last more than one week should see their doctor.

General advice for treating a concussion includes the following:

  • Get plenty of sleep at night and rest during the day.
  • Avoid visual and sensory stimuli, including video games and loud music.
  • Eat well-balanced meals.
  • Ease into normal activities slowly, not all at once.
  • Ask your doctor’s opinion about when to return to work or school.
  • Make sure to let employers or teachers know that you had a concussion.
  • Avoid strenuous physical or mental tasks.
  • Avoid activities that could lead to another concussion, such as sports, certain amusement park rides, or (for children) playground activities.
  • Get your doctor’s permission before driving, operating machinery, or riding a bike (since a concussion can slow one’s reflexes).
  • If necessary, ask your employer if it is possible to return to work gradually (for example, starting with half-days at first). Students may need to spend fewer hours at school, have frequent rest periods, or more time to complete tests.
  • Take only those drugs approved by your doctor.
  • Do not drink alcohol without your doctor’s okay. Alcohol and other drugs may slow recovery and increase the chance for further injury.
  • For some people, an airplane flight shortly after a concussion can make symptoms worse.
  • Avoid tiring activities such as heavy cleaning, exercising, working on the computer, or playing video games.
  • See your doctor again for testing before you resume your routines, including driving, sports, and play.

What if the head injury happens during a game or sport?

An injured athlete should come out of the game or practice to be tested on the sidelines by a person trained in concussion symptoms. An athlete with concussion symptoms should not play again that day, and should not play as long as symptoms last. The athlete might need to wait 1 to 2 weeks or longer before being cleared to play again.

Coaches and trainers can help the treatment process by noting the following information:

  • the cause of the injury
  • the force of the blow to the head or body
  • loss of consciousness and for how long
  • any memory loss following the injury
  • any seizures following the injury
  • number of previous concussions (if any)

When should an athlete with a possible concussion go to the emergency room?

A loss of consciousness (greater than one minute), a neck injury, or symptoms such as weakness or numbness that persists are reasons to send the athlete to the emergency room.

When can an athlete return to play after a concussion?

Before an athlete can return to play, he or she must be totally symptom-free and return to his or her concussion baseline (pre-concussion) scores. Once the athlete has returned to baseline, he or she should start a five-day program in which he or she increases activities while any symptoms are monitored. If any symptoms return, the athlete should return to complete rest.

What pain medications can be taken for a concussion?

In the first phase of concussion, the person should not take any pain medications. A pain medication can “mask” the symptoms, which could allow someone to return to activities with a concussion.

After a concussion is diagnosed, acetaminophen can be used; however, it should not be given just to cover up headaches. Aleve and ibuprofen (NSAID-type medications) should not be used at first, as they may increase the risk of bleeding.

How can I prevent concussions?

To reduce the risk of concussions:

  • Always wear seatbelts in the car and buckle children in safety seats.
  • Wear a helmet that fits when biking, riding a motorcycle, skating, skiing, horseback riding, or playing contact sports. A helmet should be secure and not move around when you shake your head. The helmet should be secure but not uncomfortably tight.
  • Prevent falls on stairs by putting up handrails.
  • Install safety gates on stairs to protect young children.
  • Put grab bars in the bathroom, with nonslip mats in the tub and on floors.
  • Improve lighting and remove trip hazards.
  • Install safety guards by windows to keep children from falling out.

What can be expected after treatment for a concussion?

Most people make a full recovery after a concussion. How quickly they get better depends on how severe the injury was, how healthy they were before the injury, and how well they follow their treatment plan. In all cases, rest is one of the most important treatments for a concussion because it helps the brain to heal.

It’s helpful to identify and avoid things that cause your symptoms. For instance, if symptoms get worse when you read for 10 minutes, decrease to eight minutes. Or if they increase with bright light, try lowering the lights or wearing sunglasses.

While recovering from a concussion, it is important to avoid anything that could cause another jolt or blow to the head or body. A repeat concussion that occurs before the brain has recovered from a first one can slow permanent recovery and increase the chances for long-lasting problems. These problems include difficulties with concentration and memory, headaches, and sometimes physical skills such as keeping one’s balance.

If I have a concussion, how likely am I to have another one?

Once you have a concussion, you are at three to five times greater risk for later concussions.

References

© Copyright 1995-2012 The Cleveland Clinic Foundation. All rights reserved.

Post concussive syndrome is defined as symptoms related to the head injury lasting greater than three months. Post concussive syndrome can be difficult to manage and frustrating for all involved, but the key to management is to breakdown the triggers that are causing symptoms and modify them to try to avoid worsening of symptoms.

We may utilize daily medications to help with headaches, neck pain or sleep. We may need to refer an individual experiencing post concussive syndrome for cognitive training or physical therapy for balance or neck issues.

Post concussive symptoms are characterized by:

  • Sleep problems
  • Deficits in memory and concentration
  • Headaches
  • Sensitivity to light as well as attention problems

These symptoms can occur soon after a concussion or develop more slowly over time.

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